Texas Life and Health Insurance

An employee elects a health flexible spending arrangement through payroll deductions. What should the employee understand about unused funds?

An employee has a qualifying termination of employment other than for gross misconduct and loses coverage under an employer plan subject to federal COBRA. What is the usual maximum continuation period for that event, before any applicable extension?

A tax-qualified long-term care policy uses the standard activities-of-daily-living trigger. Which situation most directly fits that trigger, assuming the required licensed-practitioner certification and expected duration are met?

A hospital indemnity policy promises $200 for each covered day of hospitalization. An insured has four covered days. What benefit is payable under that stated daily provision?

A critical illness policy pays a stated lump sum when the insured is diagnosed with a specified covered illness and satisfies its conditions. Which description is most accurate?

In a typical employer group health arrangement, what does an enrolled employee receive as evidence of benefits under the employer's master contract?

A disability income policy has a 60-day elimination period. What does that period generally represent?

A limited health policy has a probationary period for sickness after its effective date. How does that differ from a disability elimination period?

An individual disability policy is noncancelable to its stated age as long as required premiums are paid. What protection does that ordinarily provide during that period?

A disability policy is guaranteed renewable rather than noncancelable. Which premium change may its terms permit, subject to law?

A medical plan has a $1,000 remaining deductible and pays 80% of covered allowed charges after the deductible. An in-network covered service has an allowed charge of $6,000. No copay or out-of-pocket cap changes the result. What is the patient's share?

A member has already paid $3,800 toward a $4,000 annual in-network out-of-pocket maximum. A new covered in-network claim would otherwise require $700 of cost sharing. What is the additional cost sharing for that claim under these facts?

A health plan requires a $30 copayment for a covered office visit. Which term best describes that $30 amount?

A member obtains prior authorization for surgery. Why should the agent avoid promising that authorization guarantees payment of every related charge?

Under a health policy, how does a notice of claim differ from proof of loss?

An individual health policy says changes require a written endorsement approved by an authorized insurer officer. A producer orally promises to remove an exclusion. What should the applicant rely on?

A health policy has a valid grace period for a renewal premium. What is the main purpose of that provision?

An applicant is eligible for an ACA-compliant individual major medical policy and has diabetes diagnosed before enrollment. Which statement is correct about that preexisting condition?

A disability policy contains a relation-of-earnings provision. What concern is that provision intended to address?

A disability policy offers a future increase option. What is its usual function?